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FROM Fid;'; HLI. 1. 15 2016 12:J1Pl"l P4 <br /> State of Cal&mia-California Environmental Protection Agency Department of Toxic Substanco:Control -H1NMP <br /> PERMANENT STATE ID NUMBER APPUCATION806 Sacramento.CA 95812•0806 <br /> Please type or neatly print in ink. Please review the lino-by-fine instructions carefully- <br /> --TP check on the status of your request,go to wwvv.hwts. ca, and click on Re <br /> NEW NUMBER REQUESTS Check all that apply. <br /> El I. I am applying for (see instructions.) <br /> PP1Y 9 ne{w permanent California!D number as a hazardous waste: ❑ Generator p Transporter <br /> Reason for new number. A. Q Never had a number B. ❑ Business moved C. ❑ Legal owner of business changed <br /> !f your busigt39s generates greater then 900 kq of RCRA hazardous waste other than those hazardous waste listed in 40 CFR 289.5 <br /> subparts(c)and(d),per mon ,complete Form 8700-92 for an EPA(federal)ID number_ <br /> CI fA1NL9ES TO STATUS OR INFORM FOR ANE ISTING$TATE ID NUIMBER (See yi <br /> For existing ID number: C A L 0 0 0 2 <br /> 2 <br /> D 2. 1 am updating the rn�ailing address and/or contact information only. JUL 1 5 2016 <br /> p 3. 1 am inactivating this 1tl number. <br /> 4. 1 am reactivating this ID Number. <br /> Q 5. 1 am changing the business name only, no ownership chs e. <br /> ._ <br /> 6. Site/Facility/Business Name(Include Di3A): SB Gas & Market (See instructions.) <br /> 7_ Site Location: 515 A 11th St <br /> street - <br /> Traev CA_ 95376 San Joa uin <br /> City state Zip County <br /> 8. (a)Federal Employer 10 Number 20-3804724 (b)Board of Equalization Fee Account Number <br /> b is onlY reouimftd firm generators of groater than 5 tons rcalendery6ad <br /> 9. Mailing Add 515 11th St (see instructions. <br /> street <br /> Trac CA 95376 <br /> City State zip <br /> 10. Site Contact Parson: tan Cook (See instructions.) <br /> first Name Last Name <br /> Contact Persoil Address 515 W 11th St <br /> street <br /> TMgy CA 95376 <br /> City State Zip <br /> Contact Person Phone N tuber (zea)834-8838 Fax Number: ( ) <br /> Area Cade Phone Number Area Code Fax Number <br /> Contact Person Bush► Email Address: st)gasandmarkeWyahoo.com <br /> Preferred Primary Comm nication: Mail U Email <br /> (See instrmctions.) <br /> 11. Legal Busi Owner( property owner): Sanjay gifts <br /> First Name Last Nacres <br /> Owner Add -. 515 11th St <br /> street <br /> Trac CA 95376 <br /> city State zip <br /> Owner Phone Number. 5to 414 5390 Fax Number. ( ) <br /> Area Coria Phone Number Area Code Fax Number <br /> (see Mtruchon3.) <br /> 12. Standard Industrial Classification(SIC)Code for the Site: 5 4 1 1 (4-Digit Number) <br /> (See instructions.) <br /> 13. Certification_ 1I certify under penalty of law that tho Wnmtation on this document was prepered to the best of my knowledge and <br /> belief to be,tam,accu and complete. } <br /> SIGNATURE `` DATE -/ —13 — <br /> NAME(print) Ke Cook TITLE Manager PHONE (209) 834-8838 <br /> DTSC 1358(M29r15) <br />